Key result
Continuous positive airway pressure for obstructive sleep apnea may prevent cardiovascular events in primary prevention, but recent trials show no benefit in secondary prevention.
Why the study?
Obstructive sleep apnoea (OSA) may contribute to cardiovascular disease, but the effects of its treatment on primary and secondary prevention remain unclear.
Does continuous positive airway pressure (CPAP) prevent cardiovascular events in patients with obstructive sleep apnoea?
Does continuous positive airway pressure (CPAP) prevent cardiovascular events in patients with obstructive sleep apnoea?
While observational data supports CPAP for primary cardiovascular prevention in OSA, randomized trials show it does not prevent recurrent cardiovascular events in secondary prevention, except potentially for cerebrovascular events in highly compliant patients.
Does not support routine CPAP for secondary prevention in OSA; leaves open primary prevention role.
PURPOSE OF REVIEW: The aim of this study was to provide an update of the primary and secondary prevention of obstructive sleep apnoea (OSA) treatment on cardiovascular disease. RECENT FINDINGS: Consistent evidence suggest that OSA can contribute to cardiovascular diseases, including hypertension, atrial fibrillation, coronary artery disease and stroke. In patients with no previous history of cardiovascular events (primary prevention scenario), observational studies suggest that continuous positive airway pressure (CPAP), the main treatment for OSA, is able to prevent hypertension incidence and to decrease nonfatal cardiovascular events in men and fatal cardiovascular events in men, women and elderly. In patients with a previous history of cardiovascular events (secondary prevention scenario), recent randomized trials showed that CPAP was not able to prevent a new cardiovascular event. These findings may suggest that in patients with high cardiovascular risk and multiple comorbidities, OSA may not have an incremental role on cardiovascular disease. However, a subanalysis from the same trials showed that good CPAP compliance was able to prevent cerebrovascular events. SUMMARY: OSA may predispose to cardiovascular disease, but additional efforts for improving CPAP use or development of new treatments may help to understand the magnitude of OSA on cardiovascular disease.
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Drager et al. (2018) conducted a review in Obstructive sleep apnoea. Continuous positive airway pressure (CPAP) was evaluated on Cardiovascular events. Continuous positive airway pressure for obstructive sleep apnea may prevent cardiovascular events in primary prevention, but recent trials show no benefit in secondary prevention.
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